Bacterial infections:
Indications for: CIPRO
Susceptible infections, including lower respiratory tract, acute exacerbations of chronic bronchitis (AECB), skin and skin structures, bone and joint, acute sinusitis, complicated intraabdominal (w. metronidazole), UTIs, chronic bacterial prostatitis, acute uncomplicated cystitis in females. Postexposure prophylaxis and treatment of anthrax. Infectious diarrhea, typhoid fever, uncomplicated cervical and urethral gonorrhea: oral form only. Nosocomial pneumonia, empiric therapy in febrile neutropenia: IV form only. For AECB, acute sinusitis, and acute uncomplicated cystitis: reserve for those who have no alternative treatment options.
Adult Dosage:
See full labeling. Swallow tabs whole or can be split to provide appropriate dosage. Do not chew microcapsules for susp; swallow them whole. ≥18yrs: Acute sinusitis, typhoid fever: 500mg every 12hrs for 10 days. Lower respiratory tract, skin and skin structure: 500–750mg every 12hrs for 7–14 days. Intraabdominal (w. metronidazole): 500mg every 12hrs for 7–14 days. Bone and joint: 500–750mg every 12hrs for at least 4–8 weeks. Infectious diarrhea: 500mg every 12hrs for 5–7 days. Acute uncomplicated cystitis due to E. coli, S. saprophyticus in females: 250mg every 12hrs for 3 days (oral forms only). Other UTIs: 250–500mg every 12hrs for 7–14 days. Prostatitis: 500mg every 12hrs for 28 days. Gonorrhea: 250mg once. Postexposure prophylaxis of inhalational anthrax: 500mg every 12hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, cutaneous, GI, or oropharyngeal anthrax: see CDC recommendations. Renal dysfunction (CrCl 30–50mL/min): 250–500mg every 12hrs; (CrCl 5–29mL/min): 250–500mg every 18hrs; hemo- or peritoneal dialysis: 250–500mg every 24hrs (after dialysis).
Children Dosage:
<18yrs: usually not recommended. Swallow tabs whole or can be split to provide appropriate dosage. Do not chew microcapsules for susp; swallow them whole. 1–17yrs: Complicated UTIs or pyelonephritis: 10–20mg/kg (max 750mg) every 12hrs for 10–21 days (see full labeling). Postexposure prophylaxis of inhalational anthrax: 15mg/kg (max 500mg/dose) every 12hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, cutaneous, GI, or oropharyngeal anthrax: see CDC recommendations.
CIPRO Contraindications:
Concomitant tizanidine.
Boxed Warning:
Serious adverse reactions (including tendinitis and tendon rupture, peripheral neuropathy, CNS effects). Exacerbation of myasthenia gravis.
CIPRO Warnings/Precautions:
XR not interchangeable with other forms. Increased risk of disabling and potentially irreversible adverse reactions (including tendinitis/tendon rupture [esp. in patients >60yrs, or those with kidney, heart or lung transplants], peripheral neuropathy, or CNS/psychiatric effects); discontinue immediately if signs/symptoms occur. CNS disorders (eg, cerebral arteriosclerosis, epilepsy) that increase seizure risk. History of myasthenia gravis; avoid. Renal (except XR tabs for uncomplicated UTIs) or hepatic dysfunction: reduce dose. History of QT prolongation, ventricular arrhythmias, proarrhythmic conditions (eg, bradycardia, acute myocardial ischemia), hypokalemia, or hypomagnesemia; avoid. Increased risk of aortic aneurysm and dissection (esp. in elderly); reserve use only if no alternatives in patients with history or risk of. Discontinue at 1st sign of skin rash, jaundice, any other hypersensitivity, hepatitis, or photosensitivity. Monitor blood glucose in diabetic patients; discontinue if hypoglycemia occurs. History of joint-related disorders (esp. children). Maintain adequate hydration, avoid alkaline urine to avoid crystalluria. May mask symptoms of syphilis; test for syphilis before treating gonorrhea, then follow-up after 3mos. Avoid excessive sun or UV light. Elderly. Pregnancy. Nursing mothers: may pump/discard breast milk or avoid (during and for 2 days after the last dose); monitor infant; for inhalation anthrax (post exposure): consider risk/benefit.
CIPRO Classification:
Quinolone.
CIPRO Interactions:
See Contraindications. Avoid theophylline, duloxetine, zolpidem, drugs that prolong QT interval (eg, Class IA or Class III antiarrhythmics, TCAs, macrolides, antipsychotics). Oral forms: take at least 2hrs before or 6hrs after magnesium- or aluminum-containing antacids, sucralfate, metal cations, multivitamins containing zinc or iron, or didanosine (buffered forms). Increased risk of tendinitis/tendon rupture with corticosteroids. Severe hypoglycemia with oral antidiabetics (eg, glyburide, glimepiride); monitor. Increased seizure risk with concomitant NSAIDs. Potentiates caffeine/xanthine derivatives; monitor and adjust dose as needed. Potentiated by probenecid. Monitor renal function with concomitant cyclosporine. Monitor methotrexate, oral anticoagulants (eg, warfarin), phenytoin, clozapine, ropinirole, sildenafil. Reduced absorption with omeprazole (XR).
Adverse Reactions:
Nausea, diarrhea, abnormal LFTs, vomiting, rash; tendinitis/tendon rupture, peripheral neuropathy, CNS effects, hypersensitivity reactions, hepatotoxicity, C. difficile-associated diarrhea, torsades de pointes, dysglycemia, phototoxicity, aortic aneurysm/dissection, joint-related disorders (children). IV: also inj site reactions, eosinophilia, headache, restlessness.
Generic Drug Availability:
YES
How Supplied:
Tabs—100; Oral Susp—100mL (w. graduated teaspoon); XR Tabs—50; IV premixed, IV conc—contact supplier
